Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them – a multicenter descriptive study according to medication reviews in Hungarian community pharmacies.

The
study was a multicenter descriptive study carried out in Hungarian community
pharmacies.
The project was carried out between October 2017
and March 2018.
The research was carried
out in the framework of the training of specialist pharmacists at Semmelweis
University.

The patients enrolled had
to participate in pharmacist consultations monthly for 3 months, in which they
took part in a medication review by the pharmacists participating in the study.
During
the consultations, pharmacists carried out medication reviews on the patients'
entire drug list. If no problems were found, they dispensed the
medications. In the event of a DRP detected by the
pharmacist, a pharmacist intervention was carried out: the GP of the patient
was informed, or the problem was solved independently, on the pharmacist’s
authority. The DRPs detected were categorized by pharmacists and then
recorded in an electronic data table prepared by the authors. At the same time,
pharmacist intervention to solve the DRP was also recorded. The system used to
classify the detected DRPs divides
the problems into
six groups. In addition to the
six groups, the classification system also identifies the possible underlying
causes of a particular drug-related problem. The first consultation was followed by at least two
further face-to-face meetings monthly during the project.

From the
data collected by pharmacists, the authors determined the amount of DRPs and
interaction risks per capita and the percentage of each DRP category and
underlying cause in proportion to the total DRP.

During the
medication review, in addition to the fact of interaction risks, pharmacists wrote
down the active substances involved in the particular interactions and recorded
the pharmacist intervention(s). We determined the incidence rate of each active substance. Interaction
risks were grouped from two perspectives:
1.
Prescribing and dispensing category of the medicine, that is, which healthcare professional is
competent to provide the necessary intervention and a complete solution.
The clinical risk of the interaction based on the UpToDate Lexicomp® interaction database.

Interventions to address the DRPs revealed during
the medication review were recorded by pharmacists on the electronic data
collection sheet. The pharmacist interventions described to address the
identified interactions were grouped. More than
one intervention may have been necessary to solve one DRP.

During the
project, pharmacists used a table summarizing the full medication of the
patient, which could indicate the current problem (eg interaction and its
severity, and related warning), in addition, pharmacists provided patients with
written leaflets summarizing the general rules of medication and placed a
counseling poster in pharmacies.